Public health changes to Supreme Court decisions

BILLIONa trio of recent landmark Supreme Court rulings—relax the concealed carry-on law, overturned Roe v. Wadeand limit the power of the Environmental Protection Agency (EPA) to regulate the entire power plant emissions industry – created all manner of political and judicial counterproductives. Those who benefited from the rulings welcomed the court’s historic actions, and critics condemned them as judicially extreme behaviour.

But more important than politics is the real impact that rulings can have – in both the short and long term – on the health of Americans, whose lives are affected by any decision. regulations regarding pollution, guns and abortion.

Here are the potential public health implications of the decisions and what we can expect in the years to come as they work their way up in literal agency politics.

More polluted air — and inflammation — for all

Among the recent rulings, West Virginia Environmental Protection Agency sues has the greatest impact nationally, if only because we all share and breathe the air, and therefore we are all affected by the smog emissions produced by the country 3,477 fossil fuel-powered power plants. The ruling removed the EPA’s authority to limit emissions across that entire sector, concluding that authority went beyond the regulatory scope of what Clean Air Act of 1970 allow. Medical experts say it’s bad news for all of us.

Increased carbon emissions will lead to an exacerbation of the already urgent problem of global warming. Last year was the sixth warmest year on record and also marked the 45th consecutive year in which global temperatures rose above the 20th century average, based on National Oceanic and Atmospheric Administration. Each year, about 12,000 Americans die from extreme heat, found a 2020 study from the National Center for Biotechnology Information.

Read more: How to cool down when it’s really hot

That number is likely an underestimate, because extreme heat exacerbates all the underlying diseases like cardiovascular disease, dementia, COPD, etc – which means that the conditions themselves, not temperature, is listed as the official cause of death, Dr. Aaron Bernstein, a pediatrician at Boston Children’s Hospital, and interim director of the Center for Climate, Health and the Global Environment at the Harvard TH Chan School of Public Health. “It’s hard to debug,” says Bernstein. “People should not consider canker sores as the number one diagnosis on their death certificates.”

Of course, it’s not just temperature that causes harmful smoke emissions. So are the main pollutants emitted by power plants, especially sulfur dioxide, nitrogen oxides, carbon dioxide, mercury and particulate matter – the last of which are of particular concern.

According to EPACrude particulate matter has been linked to childhood asthma, a condition that the US Centers for Disease Control and Prevention speak affects more than 4.2 million American children 18 years of age and younger.

But particulate matter of all sizes is associated with more than asthma. “Particle matter is inflammatory,” says Bernstein. “When these particles enter our bodies, they glow, causing damage to everything — the brain, the blood, the heart, the lungs.” Bernstein says such inflammation can worsen depression and anxiety and may even be linked to suicide — a connection supported by a meta-analysis published in 2019 in the magazine Environmental health perspective. Dr Ceclia Sorensen, professor of emergency medicine and environmental health sciences at Columbia University, said Alzheimer’s disease can also be aggravated by air pollution.

Not all Americans suffer from air pollution to the same extent, and — as usual — people of color and lower-income communities are hit hardest, as the chart below shows. shows. Disproportionate share of fossil fuel-powered power plants in the US located in or near low-income, non-white, and non-English speaking communities, as well as communities where most people have less than a high school education.

“Air pollution is not an equal opportunity killer,” says Bernstein.

Sorensen sees a ruthless cycle in this kind of demographic disparity. “People who are already economically disadvantaged are increasingly receiving larger medical bills and more health problems, which further undermines their ability to escape poverty,” she said. “Have a lot of environmental justice issues across the country — pocket money in every city, every state, every urban economy. “

It’s more dangerous in public now

An entirely different kind of public risk is posed by New York State Rifle & Pistol Association sues Bruen, the Supreme Court’s controversial gun control ruling. The case concerns New York State law that requires gun owners within state borders to obtain a permit to carry a concealed firearm outside their home and to demonstrate “good cause” for obtaining that license. That means they must show that their job or some other special circumstance requires them to be armed, rather than simply choosing to carry a gun in self-defense. The court removed the good cause clause, replacing the requirement for a license, but making a license significantly easier. Six other states — California, Hawaii, Maryland, Massachusetts, New Jersey, and Rhode Island — have similar laws on books, and their states are now encouraged as well.

It’s disturbing news in a reeling country more than 300 mass shootings so far in 2022 — even with a modest but realistic gun safety bill recently passed by Congress and signed into law by President Joe Biden. Experts worry the more guns you carry, the more shootings you’ll have.

Nick Suplina, senior vice president of law and policy at Everytown on Gun Safety. “It could mean a scary situation in the subway that leads to a person drawing and firing their concealed weapon. There are states where it is not allowed to drive where the fenders bend [lead to gunfire] because temper flares up. “

Those concerns are not just speculation. One year 2017 paper The National Bureau of Economic Research found that states that weakened handgun laws saw an 11% increase in homicide rates and a 15% increase in violent crime rates within the 10 years since law is passed. One 2022 paper by the same team that analyzed gun laws in 47 cities and found that concealed carry laws were linked to a 29% increase in violent gun crime. “Increased public carrying leads to worse public safety outcomes,” says Suplina.

In his dissent in Bruen’s decision, Justice Stephen Breyer cited 45,222 Americans killed by firearms in 2020 – a number that Jon Lowy, vice president and chief counsel of the anti-violence group gun Brady, called “a public health crisis.” Public health experts agree on that classification. Dr Jack Resneck, Jr., president of the American Medical Association, said: “As leaders in the medical profession, our unique view of gun violence as a health crisis is Serious community informed by scientific research and clinical experience of physicians”. statement. “In emergency departments around the country, doctors are first-hand witness to the scourge of gun violence while caring for victims of preventable, life-threatening injuries. Okay.”

“Society should address the issue holistically,” Lowy said, “including strengthening gun laws, requiring more effective safety features, requiring more affordable sales, and Educate the public carefully. This is what we do with tobacco, vehicle and drug deaths.”

Of course cars, cigarettes and opioids are not allowed to amend the Constitution to support them, and guns do. As a result, Brady is helping states — especially those with New York-style laws — to draft new legislation that would limit concealment as much as possible, consistent with Bruen decision. The Supreme Court did not forbid redressing the new ruling: for example, allowing a ban on carrying traces in “sensitive places” such as schools, government buildings and polling places. As soon as the decision is made, New York passed the law lists 14 such sensitive locations, including any place where alcohol is served, any place where children congregate, entertainment venues, houses of worship, healthcare and medical facilities, and Quang Ninh. Manhattan’s Times School.

Similar laws may be followed in other states. But in a country with more guns than peopleThe public health crisis is not going away anytime soon.

The body is less autonomous — with riskier outcomes

The best assist in the recent Supreme Court trilogy is Dobbs sues Jackson Women’s Health Organizationthe decision that overturned the old century by almost half a century Roe v. Wade The ruling makes abortion a constitutional right. Besides, women will face real health impacts in the post-Roe era.

The United States is already a dangerous place to get pregnant, with a maternal mortality rate of 24 deaths per 100,000 live births – much higher than rates in comparable advanced countries, as shown in the chart below. shows. For black women, the rates are particularly alarming: 55 deaths per 100,000 live births. Banning or severely restricting abortion means that many high-risk pregnancies that have been terminated will instead lead to full-term pregnancies, with potentially disastrous outcomes for the mother, like Jamie TIME’s Ducharme reported.

One Research in 2021For example, it was found that if the United States banned abortion altogether, pregnancy-related deaths would increase by 20% overall and 33% among Black women. Even in 2017, prior to the Dobbs ruling, the maternal mortality rate was 28.5 deaths per 100,000 live births in states with strict gestational age limits on abortions or waiting periods. waiting before having the procedure, compared with 15.7 such deaths in states that protect access to abortion through the first trimester, according to one research published in a magazine Contraception.

Other factors may also contribute. Countries that restrict access to pre-abortionDobbs often facilities that don’t expand Medicaid under the Affordable Care Act and have fewer practicing medical professionals — increasing the risks associated with pregnancy in general. These states are home to a disproportionate amount of people of color living in poverty.

That’s not to say that in a post-Roe world, maternal health is likely to suddenly be valued by society. Instead, the hard work of being pregnant will now become a lot more dangerous.

Other must-read stories from TIME

Write letter for Jeffrey Kluger at [email protected].

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